Endodontic Diagnosis

Hello. This presentation today is on endodontic diagnosis.

My name is Doctor Keith Boyer. I'm an endodontist at Western University of Health Sciences College of Dental Medicine to comprehend endodontic diagnosis.

It is necessary to understand how endodontic disease occurs. Caries or other damage to the dental pulp causes localized inflammation.

The pulpal inflammatory response consists of increased permeability and dilation of the blood vessels resulting in tissue swelling in reversible pulpitis.

The pulp can mount an immune response and recover from short term insult by shunting away the excess fluid when the injury is severe or persists because the pulp tissue is enclosed in a low compliance space.

There is no room to expand and the pressure continues to build until the vessels collapse leading to tissue damage. This condition is called irreversible pulpitis.

As microorganisms invade the disease, pulp tissue, it becomes necrotic and infected. Inflammatory and bacterial byproducts build up in the root canal, escape through the apical foramen and cause apical periodontitis or inflammation of the periradicular tissues.

Here, the body's defenses initiate an immunologic response. The interaction between host and pathogen may cause bone resorption or produce pus resulting in abscess formation when the purulence is confined to the bone or soft tissue.

This is known as acute apical abscess, chronic apical apsis occurs when drainage of the pus is established, such as through the gingival sulcus onto the gingiva into the maxillary sinus or to the facial skin.

The key to diagnosing an endodontic problem is to listen to the patient. It begins by taking a history of the chief complaint which should include location duration, quality, severity, stimulus relief, and dental history related to the area.

In question, based upon the patient's symptoms, one should be able to form a hypothesis as to the diagnosis, the clinician will then test the hypothesis by collecting data with an oral hard and soft tissue exam, radiographs and diagnostic tests.

The objectives are to locate the potential cause of the problem. Look for signs of disease and ultimately reproduce the patient's chief complaint.

If the patient reports pain on chewing, then percussion or biting tests are necessary. If they experience temperature sensitivity, then the dentist should apply cold and possibly heat to the teeth.

If pulpal necrosis is suspected, a lack of response to cold or electrical stimulus may confirm it after isolating the tooth that reacts the same way as the chief complaint.

Correlating tests with the clinical findings and verifying probable etiology. Then a diagnosis is established and an endodontic treatment plan is determined if the information does not all line up, then the options are to either wait until symptoms become clearer or refer if the cause is suspected to be complex or nonodontogenic endodontic treatment should not be initiated unless a diagnosis has been established.

Each tooth will have both a pulpal and periapical diagnosis. The pulpal diagnosis is tested by thermal or electrical stimulus.

A delta nerve fibers near the pulp's periphery create sharp quick pain signals in response to stimulus. This sort of response can be found in health or pulpitis, minor sensitivity to cold in a test tooth that is consistent with other control.

Teeth would suggest normal pulp, short-lived pain to cold is found in reversible pulpitis. Long lasting intense pain to cold occurs in symptomatic irreversible pulpitis.

This response happens when damage has occurred and the sea fibers in the center of the pulp are activated, creating a lingering throbbing and often spontaneous pain.

Asymptomatic irreversible pulpitis presents with minor sensitivity or short lived pain, but the pulp is clearly exposed by caries or trauma.

No response to cold or electrical stimulus occurs in pulp necrosis or previously treated teeth previously treated means that the tooth has already had root canal treatment with filling material in the roots.

Previously initiated therapy can have possible sensitivity or no response depending on the level of treatment that was begun.

The periapical diagnosis is confirmed by a combination of radiographs and tests teeth that have no pain to percussion of the tooth or palpation around the apex and with no apparent radiographic changes of the periradicular bone are said to have normal apical tissues.

Symptomatic apical periodontitis is determined when the patient experiences pain to percussion, palpation or biting. In these cases, there may or may not be radiolucent changes on the radiograph when there are radiolucent areas surrounding the apex of the root but no pain with periapical tests.

Then the diagnosis is asymptomatic apical periodontitis, acute and chronic apical abscesses were described earlier. Acute apical abscess, usually has severe pain and may or may not have radiographic changes due to its quick onset chronic apical abscess usually has little to no discomfort and the presence of apical radiolucency.

Since the infection has eroded away at the periodontium releasing the pressure. Lastly, in some instances of chronic inflammation, bone proliferation can occur instead of resorption.

This is called condensing osteitis. And it is observed with greater radiopacity around the apex of the tooth and usually no pain.

It can however be combined with the other periapical diagnoses already discussed. In summary endodontic diagnosis relies on an understanding of the pathophysiology.

A detailed history of the chief complaint along with clinical findings and tests, verifying the patient's symptoms allows the clinician to arrive at a diagnosis which should include both a pulpal and periapical component.

Only after the diagnosis is established. May treatment begin